二级公立医院实行托管模式前后效率比较研究——以广东省某市为例

目的：研究广东省某市取消托管前后上级医疗机构基于医疗质量的运营效率。方法：采用回顾性对照研究,利用投入导向的SBM-Undesirable模型与Malmquist指数模型,基于文献研究所得的投入产出指标,结合医疗质量指标,对上级医疗机构取消托管前后效率进行测量评价。结果：2014年取消对社区卫生服务中心托管后,上级医疗机构的病床周转次数小于托管前水平,平均住院日逐年上升;2012-2016年期间,综合技术效率值分别为0.82、0.86、0.87、0.88、0.83,纯技术效率无显著变化,综合技术效率值的变化与规模效率变化呈相同趋势。全要素生产率指数为1.019、0.966、0.934、0.988。结论：取消托管后,上级医疗机构服务量增幅减小,其效率呈下降趋势;不同医疗机构规模效率存在区域差异。上级医疗机构与社区卫生服务中心应积极响应国家号召,因地制宜构建整合型医疗服务体系,在不同片区精准配置医疗资源,使有限的医疗资源得到充分利用,提高居民健康水平。

A comparative study on the efficiency before and after the implementation of the trusteeship model among secondary public hospitals: A case of a city in Guangdong

Objective:To study the operational efficiency of high-level medical institutions based on medical quality before and after the cancelation of trusteeship model in a city in Guangdong Province. Methods:By adopting a retrospective controlled study, using the input-oriented SBM-Undesirable model and Malmquist model, based on the input-output indicators obtained from literature research and combined with medical quality indicators, the efficiency of high-level medical institutions before and after the cancellation of trusteeship was measured and evaluated. Results:After canceling the trusteeship of the community health service centers in 2014, the number of bed turnovers of high-level medical institutions was less than the pre-trusteeship level, and the average hospitalization days increased year by year. During the period from 2012 to 2016, the technical efficiency values (TE) were 0.82, 0.86, 0.87, 0.88 and 0.83, respectively. There was no significant change in pure technical efficiency (PTE). Even though the change in TE was not significant, it showed similarities in trend as the change in scale efficiency (SE). Total factor productivity values (TFP) were 1.019, 0.966, 0.934 and 0.988, respectively. Conclusions:After canceling the trusteeship model, the service provision in high-level medical institutions underwent a slight decrease in speed, and their efficiency showed a downward trend. There were regional differences in terms of SE among different medical institutions. High-level medical institutions and community health service centers should actively respond to the call of the government, build a integrated medical service system in accordance with the local conditions, accurately allocate medical resources in different areas, make full use of limited medical resources at hand, and improve the health of residents.